Provider Demographics
NPI:1306358544
Name:GARRETT, RONDA R (SUDP)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:R
Last Name:GARRETT
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E MAGNESIUM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5901
Mailing Address - Country:US
Mailing Address - Phone:253-217-2691
Mailing Address - Fax:509-474-1796
Practice Address - Street 1:101 E MAGNESIUM RD STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5901
Practice Address - Country:US
Practice Address - Phone:509-368-9021
Practice Address - Fax:509-474-1796
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003826101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)